Medicare Advantage Plans

Frequently Asked Questions

What is Original Medicare?

Medicare is a federal health insurance program for people 65 years old or older, certain disabled people younger than 65, and people with End-Stage Renal Disease.

How does Medicare work?

Medicare has four parts:

  • Medicare Part A is hospital insurance that helps pay for hospital stays, rehabilitative nursing facilities, home health care, and hospice. You likely won’t have to pay a premium for Part A, because you prepaid the premium through payroll taxes while you were working. You are generally automatically enrolled in Medicare hospital insurance (Part A) without a premium, when you apply for Social Security benefits – usually upon reaching 65 years of age, or after receiving disability payments for two years and if you have 10 years of creditable employment. Part A helps cover inpatient care in a hospital or a limited stay in a skilled-nursing facility.

  • Medicare Part B is medical insurance that helps pay for doctors' services and outpatient care. You’ll pay a monthly premium for Part B. If you don't sign up for Part B when you become eligible at age 65, or when you have been disabled for two years and you decide you need to join in the future, you may have to pay a penalty for each year you were eligible but didn't enroll. Part B of Medicare helps cover physician and outpatient hospital services. You are responsible for paying the Part B premium that is usually deducted from your Social Security benefits. Medicare pays for many healthcare services and supplies, but not all of your healthcare costs. For example, you pay a deductible for each hospital stay and may typically pay coinsurance anytime you use the services of a physician or surgeon. Also, drug coverage is limited. Because Medicare rarely pays the full cost of covered services, you may want to consider a Medicare Advantage or Medicare Supplement plan.

  • Medicare Part C is the Medicare Advantage program. With this option, you can choose to have your Medicare Parts A and B provided by a private insurance company like CarePlus. A Medicare Advantage plan provides Part A and Part B coverage, and, generally, additional benefits.

  • Medicare Part D is prescription drug coverage. Part D is like Part B – if you don’t enroll in Part D at age 65, you may have to pay a penalty when you enroll.

What is Medicare Advantage?

Medicare Advantage is a type of health plan that lets you get your Original Medicare benefits from a private insurance company. The Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003 created Medicare Advantage. Some examples of Medicare Advantage plans are:

  • Health Maintenance Organization plans (HMO)
  • Preferred Provider Organization plans (PPO)
  • Private Fee-for-Service plans (PFFS)

What is a Medicare Advantage HMO?

An HMO features specific lists of in-network doctors, hospitals, and other providers that you must use to receive benefits. Medicare Advantage HMOs often provide additional benefits not found in Original Medicare, including reduced cost-sharing, prescription drug coverage and wellness or fitness programs. If you select a Medicare Advantage HMO, you use it instead of your Original Medicare coverage. However, you can return to Original Medicare down the road if you wish.

What is the Medicare Part D drug benefit?

Anyone entitled to Medicare Part A or enrolled in Medicare Part B, regardless of income, is eligible to enroll in Medicare Part D, which is a prescription drug benefit plan. This benefit was designed to help Medicare consumers access and pay for prescription drugs.

What is a Prescription Drug Plan (PDP)?

A PDP is a private stand-alone prescription drug plan (PDP) that offers coverage for prescription medications, Part D. You can use this plan with Original Medicare or with a Medigap plan. CarePlus does not offer a stand-alone prescription drug plan. Prescription drug coverage is included on all our Medicare Advantage plans.

You cannot enroll in more than one PDP at the same time, or in a PDP and a Medicare Advantage plan that includes prescription drug coverage (MAPD). Exceptions include Medicare Advantage PFFS plans that do not offer the Part D benefit, a Medicare Savings Account (MSA), or exceptions provided under CMS waiver authority.

If you are considering a PDP, please keep the following in mind:

  • Optional plan. A PDP is an option – not a requirement. However, if you don't join a PDP or a Medicare Advantage plan with prescription drug coverage, or have a prescription drug plan (PDP) as good as a plan you can get through Medicare, you won’t have coverage for your prescription drugs and will have to pay a higher premium if you join later.
  • Monthly premium. PDPs have a monthly premium. Some Medicare Advantage plans offer medical and prescription drug coverage together for one monthly premium. All CarePlus plans are MAPDs, which are Medicare Advantage plans that include prescription drug coverage. In addition to the plan premium, you must continue to pay your Medicare Part B premium, unless the State Medicaid Program pays your Part B premium for you.
  • How does a PDP plan work with a Medicare Advantage plan? If you are enrolled in a Medicare Advantage plan, such as an HMO through a private insurance company, you may have prescription drug coverage. If so, choosing a PDP is not necessary – in fact, getting a PDP would disenroll you from your Medicare Advantage coverage. All CarePlus plans are Medicare Advantage plans and include prescription drug coverage.

What is the difference between a preferred cost-share and standard cost-share pharmacy?

Preferred cost-share pharmacies provide prescriptions for our Medicare members at a lower cost-share (e.g., copayments) than standard cost-share pharmacies.

Standard cost-share pharmacies provide prescriptions for Medicare members at a higher cost-share (e.g., copayments) than preferred cost-share pharmacies.

What questions should I consider when choosing a Medicare health plan?

Before you select a plan, carefully consider the following questions:

  • Do you have a doctor you like?
  • Are you choosing a new doctor?
  • Do you want the ability to go to any doctor and any hospital?
  • What are your current or previous health conditions?
  • Do you need a prescription drug plan (PDP)?
  • What prescription drugs are you currently taking?
  • Does the plan's formulary (drug list) include the prescription drugs you take?

When can I actually enroll into a Medicare Advantage (MA) plan?

If you recently became eligible for Medicare, through age or disability, you generally have the option to apply for coverage in a Medicare Advantage plan close to the date when your Medicare Part A and Part B coverage starts.

Your Medicare Advantage plan can't start before both your Part A and Part B coverage begins. However, you generally have a period of seven months to apply for coverage in a Medicare Advantage plan.

This means you can apply for coverage in a Medicare Advantage plan three months before, the month of, or three months after your Medicare Part A and Part B coverage starts. You must be enrolled in Medicare Part A and in Medicare Part B. This period is known as the Initial Coverage Election Period (ICEP).

Already enrolled in Medicare?

If you didn't recently become eligible for Medicare, your enrollment options are different and may be limited to certain times during the year.

October 15 – December 7 – Annual Election Period (AEP):

The Medicare Annual Election Period (AEP) runs from October 15 through December 7 of each year. During this time, Medicare beneficiaries may change and/or enroll in a stand-alone prescription drug plan (PDP) and/or a Medicare Advantage plan, or return to Original Medicare. Changes you make during this period will take effect on January 1.

April 1 – December 31 – "Lock-in" Period:

Medicare beneficiaries usually cannot switch coverage between April 1 and December 31. This time is referred to as the "lock-in" period. During this “lock-in” period, you generally must stay with your current plan until December 31. On January 1, the coverage you choose between October 15 and December 7 goes into effect.

Special Election Period:

In certain situations, beneficiaries may be able to join, switch, or leave a Medicare Advantage plan or a prescription drug plan (PDP) during a Special Election Period (SEP).

An SEP is a period outside of the ICEP or AEP when an individual may elect a plan or change his or her current plan election. Some examples of special election situations are:

  • The organization does not renew its contract with CMS.
  • You recently moved to the plan coverage area.
  • You have Medicare and Medicaid.
  • You are disenrolling from an Employer’s or Union’s health coverage.
  • You want to enroll in a plan that received a 5-star rating from Medicare for that plan year.
  • You enter, reside in, or leave a long-term care facility.
  • You qualify for “Extra Help.”
  • You involuntarily lost creditable prescription drug coverage.
  • Other exceptional conditions may exist, as determined by CMS.

Where can I get more information about Medicare Advantage and Prescription Drug Plans, Medical Assistance and my Social Security benefits?

For more information about Medicare Advantage or prescription drug plans you can call the Centers for Medicare & Medicaid Services (CMS), or go online:

Centers for Medicare & Medicaid Services (CMS)

Website: www.Medicare.gov (link opens in new window) 

1-800-633-4227

TTY: 1-877-486-2048

24 hours a day, 7 days a week

For more information about Medical Assistance through the state, you can contact Florida Medicaid or call your State Health Insurance Assistance Program (SHINE).

Florida Medicaid (Agency for Health Care Administration)

Website: www.ahca.myflorida.com (link opens in new window) 

1-888-419-3456; Press Option 2 for general information about Medicaid

TDD: 1-800-955-8771

Address: 2727 Mahan Drive, Tallahassee, FL 32308

Monday through Friday, 8 a.m. to 5 p.m.

Serving Health Insurance Needs of Elders (SHINE)

Website: www.FloridaShine.org (link opens in new window) 

1-800-963-5337

TTY: 1-800-955-8771

Fax: 1-850-414-2150

Address: 4040 Esplanade Way, Suite 270

Tallahassee, FL 32399-7000

Monday through Friday, 8 a.m. to 5 p.m.

Email: information@elderaffairs.org

For more information about Social Security or Railroad Retirement earnings, call or go online:

Social Security Administration (SSA)

Website: www.SSA.gov (link opens in new window) 

1-800-772-1213 (Generally, you’ll have a shorter wait time if you call during the week after Tuesday.) https://www.ssa.gov/agency/contact/phone.html (link opens in new window) 

TTY: 1-800-325-0778

Monday through Friday, 7 a.m. to 7 p.m.

U.S. Railroad Retirement Board

Website: www.rrb.gov (link opens in new window)

1-877-772-5772

TTY: 1-312-751-4701

24 hours a day, 7 days a week

Address: 844 North Rush Street

Chicago IL, 60611-1275

What is Adobe Acrobat Reader® and why do I need it to view various documents on this website?

Several documents on this website are in Portable Document Format – otherwise known as PDF. These files contain complex documents with graphs, images, and special text that cannot be presented easily through a regular Web browser such as Internet Explorer® or FireFox®. This format also allows you greater flexibility when printing.

The software for viewing these documents is available as a free download from the Adobe Systems website at http://get.adobe.com/reader/ (link opens in new window) . Installation instructions are also available there.

Want to Learn More?

To find answers about CarePlus, please logon to the MyCarePlus Member Portal and check out the new Journey Guide Booklet for members.

MyCarePlus Member Portal

MyCarePlus Frequently Asked Questions - English (link opens in new window) 

MyCarePlus Frequently Asked Questions - Spanish (link opens in new window)